Posts tagged ‘Holly Whiteside’

Training Family Reinterpretation (continued from Learned Helplessness, Part 2)

Holly:
This idea of reinterpretation comes up often during caregiver coaching sessions. What other kinds of reinterpretation crop up in your work with clients?

Debra: Well, Holly, it can come up in the way a family member talks about their loved one’s condition. From a medical perspective, I may be working with a client in the kitchen to functionally walk with their mobility device to retrieve items from the cabinets and refrigerator for meal-prep. The family will say, She’s not walking! I have to counter, No, she’s walking, but she’s doing it differently. We need to help the family to see the picture differently, to reinterpret what is happening.

Or if someone has had a stroke, and one side has some paralysis, a family member will say, That’s the bad hand” or “bad side.” We have to help them to see that there’s no such thing as good or bad, it’s always a matter of degree of functionality.

Holly:
Oh yes, the words caregivers use directly impact their own peace of mind and that of their loved ones. In my book, “The Caregiver’s Compass,” a main focus is noticing the words one is using, and then switching them to words that are more empowering. The theory is called “action language,” the idea that language doesn’t just describe reality, it creates it. Speaking is an action that generates your experience of your world. Self-talk is an example. But in life, we don’t live in isolation, so we’re like fish swimming in a goldfish bowl—what we say also creates realities or meanings for those around us. A daughter saying to her dad, “You’re not walking!” as he’s inching forward on his walker, is not helpful. It’s disempowering. When I run into someone negative, I’ve been known to say, “Stop pooping in the fishbowl!”

—Holly Whiteside, caregiver’s coach & advocate, is author of “The Caregiver’s Compass: How to Navigate with Balance and Effectiveness Using Mindful Caregiving.” She invented Mindful Caregiving tools during her caregiving decade by applying to herself the life coaching principles that she had been teaching others. Find her book at Amazon.com, or learn more at www.CaregiversCompass.com. Holly can be reached at MindfulCaregiving@comcast.net.

Holly:
This topic of family dynamics is so rich, Debra. Are there other ways in which you encounter and work with family dynamics?

Debra:
Sure. For instance, when there’s a disability issue, there almost always needs to be a shift in family dynamics, because our goal is client empowerment. The client’s roles and responsibilities may have been changed due to the illness, injury or disability, while other family members may have to take on new roles and responsibilities. These changes are both sources of possible stress on the family dynamics. These stresses require a shift in family dynamics or the family runs the risk of promoting helplessness in their loved one.

As the OT, I do a lot of family training around the client’s ability, showing family how independent the client is, or can be. I find many times family members aren’t nearly as patient as I am with my client. They may have to watch their loved one struggle taking off a shirt or tying a shoe. Ideally, to truly help the person without taking over, getting dressed may take two hours. But that might not work for the family. We want the client to be as independent as possible, so we have to get it across to the family member that sitting on your hands can be helping. It’s important to give the client the time that they need.

It can be a critical choice; either the family member does a task faster, OR they support their loved one in working toward independence. Doing everything for the disabled loved one promotes what we call “learned helplessness.” It doesn’t help the client to be as independent as possible. We need to meet everyone’s needs, or at least find a compromise that works.

This pattern of learned helplessness can be compounded by a family’s culture. Especially in transgenerational households, people are more family oriented, helpful (at times to a fault,) and they may have specific habits, roles and responsibilities to which they are accustomed. Out of love, the family may want to do everything. It may just be an inherent part of their culture. As OTs we have to be respectful of the culture, yet still be an advocate for the wellness of the client. We draw a balance and try to teach them new ways of being loving.

Holly:
That’s beautiful Debra, and such a challenge. This comes up regularly with caregivers. I find it helpful to teach them about the distinction between helping, fixing, and true service. Rachel Naomi Remen (Clinical Professor of Family and Community Medicine at the UCSF School of Medicine) spells out the difference between fixing, helping, and serving in her book, “My Grandfather’s Blessings.” To sum it up briefly here, chronic helping supports the helplessness or neediness of the other, and fixing presupposes that the other is broken. Though helping, fixing and serving can look alike to the observer, the inner experiences differ. Over time, fixing and helping are draining, while service is renewing. When we serve, our work sustains us.

Robert K. Greenleaf, gives us the litmus test to know whether we are truly serving our loved ones. “Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous?”

So really, Debra, we’re talking about helping caregivers to reinterpret their role, changing it to a partnership with their loved one in a way that empowers them, helping them to grow and to be as independent at possible. This idea of reinterpretation comes up often during caregiver coaching sessions. What other kinds of reinterpretation crop up in your work with clients? (to be continued…)

—Holly Whiteside, caregiver’s coach & advocate, is author of “The Caregiver’s Compass: How to Navigate with Balance and Effectiveness Using Mindful Caregiving.” She invented Mindful Caregiving tools during her caregiving decade by applying to herself the life coaching principles that she had been teaching others. Find her book at Amazon.com, or learn more at www.CaregiversCompass.com. Holly can be reached at MindfulCaregiving@comcast.net.

Debra:
We all are touched by injury, illness or disability. At EmpowerAbility, LLC, we know that for a client, everyone in their immediate circle plays a role in how well they heal. Whether I’m completing a home assessment, or working directly with the client in Occupational Therapy, it’s not just about the client, it’s about everyone around that person. It’s making sure that the environmental modifications I’m recommending in the home work for everyone.

The time we spend is frequently an almost equal split between time with the family and time with the client. In OT, we have to simultaneously be aware of everyone’s capabilities, limitations, and expectations. One example was with a caregiver whose father had Alzheimer’s. OT was a lifesaver. We were able to pull the daughter aside and help her sidestep burnout, by giving her strategies that helped her complete daily living activities while emphasizing the positive aspects of care. We gave her strategies for communicating with her father that let her get back in touch her values and social relationship that underlie her caregiving role. We also found her local resources that provided respite care (giving caregivers that much needed break,) and also caregivers groups where she could talk with others who fully relate to the caregiving role.

Everywhere along the spectrum, from acute care to outpatient and home health Occupational Therapy settings, the families are involved.

Holly:
So, Debra, you’re really talking about holistic wellness within the family system. Often the caregiver is the one left out of that picture because self-care can seem counter-intuitive from the caregiver’s perspective. Initially, there’s a sort of blindness caused by resisting what is happening, feeling they must “fix” the situation or their loved one. “I’m trying to help my dad, to slow down his decline, and you’re suggesting that I focus on myself?!” That blindness prevents them from seeing their role in the bigger picture. Seeing caregiving with a broader view requires a new way of seeing for the caregiver. Once they ease up on their resistance and begin to accept that changes are normal and inevitable, they become freer to question, “What is My part in this?” And then they are more open to seeing the need for their own self-care.

So, caregiving is rife with unknowns and things that can’t be controlled. The one thing over which caregivers do have control is their own health and well-being. The family is a dynamic system—what one family member says, and how they are, effects the others. If I’m a caregiver experiencing a mood, it can infect others. If I’m letting myself get burned out, I’m not available to do the caregiving to which I’ve committed. So in order to do my best job, I am actually required to take care of myself, get the support I need, manage my emotions honestly and well. Selfcare is no longer a frill—it’s a necessity.

This topic of family dynamics is so rich, Debra. Are other ways in which you encounter and work with family dynamics? (to be continued)

—Holly Whiteside, caregiver’s coach & advocate, is author of “The Caregiver’s Compass: How to Navigate with Balance and Effectiveness Using Mindful Caregiving.” She invented Mindful Caregiving tools during her caregiving decade by applying to herself the life coaching principles that she had been teaching others. Find her book at Amazon.com, or learn more at www.CaregiversCompass.com. Holly can be reached at MindfulCaregiving@comcast.net.